Results Summary

What was the research about?

The rate of major depressive disorder, or MDD, among teens has gone up over the last decade. Having MDD increases the risk for suicide, the second leading cause of death among teens. School-based screening can help identify teens with MDD and get them treatment.

In Pennsylvania, all schools have the Student Assistance Program, or SAP, that helps students with issues affecting success in school. Trained SAP staff can confirm if MDD symptoms require follow-up and refer students to school or community services if needed.

In this study, the research team compared two types of MDD screening for high school students:

  • Universal, or broad screening. All students completed a nine-question screener for MDD on an iPad. Students with MDD symptoms received a referral to their school’s SAP. Any student with suicidal thoughts received immediate services.
  • Targeted, or focused screening. Teachers, staff, and parents referred any students with concerning behavior to their school’s SAP. Schools in Pennsylvania currently use this approach for screening.

The research team wanted to learn which type of screening identified more students with MDD and helped get them treatment, especially those often missed in focused screening.

What were the results?

By the end of the school year, compared with students who received focused screening, students who received broad screening were:

  • Almost six times more likely to have their MDD symptoms identified through their school
  • More than three times more likely to have their need for follow-up services confirmed by the SAP
  • Two times more likely to start MDD treatment

Compared with focused screening, broad screening was better at identifying MDD among students who were female, Hispanic, or a race other than White or Black. These students are often missed in focused screening.

Rates of starting treatment didn’t differ by student sex, race, or ethnicity between the two types of screening.

Who was in the study?

The study included 12,909 students in 14 public high schools in Pennsylvania. Among students, 45 percent were White, 22 percent were Black, 21 percent were Hispanic, and 12 percent were another race or ethnicity. The median age was 16, and 54 percent were boys.

What did the research team do?

The research team assigned schools by chance to offer broad screening to students in either 9th and 11th grades, or 10th and 12th grades. Students in the other grades received focused screening.

School SAP teams tracked students who came to see them, who they referred for services, and who started treatment.

School staff, physical and mental health clinicians and advocates, parents, and teens provided input throughout the study.

What were the limits of the study?

Schools that chose to take part in the study had strong SAP teams. Results may differ for schools that don’t have SAP teams or whose teams are less prepared.

Future studies could look at broad screening for MDD in high schools in other states.

How can people use the results?

Schools can use these results when looking at how to identify students with MDD and get them treatment.

Final Research Report

View this project's final research report.

Engagement Resources

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers asked for clarification about the measurement of primary outcome for the study and whether the outcome was a composite as described in their Clinicaltrials.gov registration. The researchers explained the three parts of the primary outcome: identification of depression symptoms, confirmation that the symptoms warrant further evaluation, and initiation of treatment by the student identified. The researchers examined the percentage of each of these outcomes out of the total students in each trial arm. The researchers explained that they had initially considered this a composite outcome but previous reviewers preferred for the three metrics to be discussed individually.
  • The reviewers expressed concern about the delivery of the intervention by school staff rather than trained professionals and the resulting low rate of treatment initiation for students exhibiting depressive symptoms. The researchers explained that staff confirming depression diagnoses were trained for this work, and that requiring an outside professional to confirm diagnoses would have made implementation of the universal screening more prohibitive for many schools. The researchers also acknowledged the low rate of treatment initiation compared to the number of students identified as depressed but noted that they only measured treatment initiation within the Student Assistance Program and did not track whether students received treatment outside of the program.

Conflict of Interest Disclosures

Project Information

Deepa L. Sekhar, MD, MSc
Penn State Health Milton S. Hershey Medical Center
$2,029,903
10.25302/05.2023.AD.2017C38752
Comparing Universal versus Targeted School Screenings for Depression among Teens -- The SHIELD Trial

Key Dates

August 2018
December 2022
2018
2022

Study Registration Information

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Last updated: September 24, 2023